May 23, 2016Development and Operation of Hospital Infrastructure of Ixtapaluca (DOIHI), an organization that manages assets and tools at the Regional Specialty Hospital of Ixtapaluca (HRAEI), in Mexico, is preparing to use passive ultrahigh-frequency (UHF) RFID tags to track 11,000 surgical instruments, in order to ensure that none are misplaced before, during or after surgery. The deployment will follow a pilot involving the RFID-tagging of 500 tools. The RFID solution was provided by Mexican systems integrator HTK. The technology is also being used to track medical equipment, furnishings and other assets.
Jorge Mario Lopez Arango, DOIHI's general manager, described the deployment at the RFID Journal LIVE! 2016 conference and exhibition, held earlier this month in Orlando, Fla.
Located approximately one hour southeast of Mexico City, HRAEI opened five years ago and now serves a community of five million people. It contains 246 patient beds, 69 ICU beds, 30 emergency beds and 14 operating rooms. DOIHI, a division of Mexican construction company GIA, provides the hospital's surgical tools, maintaining and sterilizing them before reuse. DOIHI also manages assets and has installed a real-time location system (RTLS) in the facility's maternity ward.
Initially, says Gabriel Haddad, HTK's CEO, DOIHI sought RTLS technology only to ensure infant safety. The organization purchased a solution from HTK consisting of Elpas active UHF RFID transponders attached to wristbands worn by babies and mothers, as well as RTLS badges worn by nurses and doctors. Reader antennas were installed in the ceilings at various points throughout the maternity ward, Haddad says. The software identifies when babies are being moved from the nursery, based on their wristband's location, as well as whether they are on an expected route (toward the mother's room, for instance), and whether they are accompanied by the nurse assigned to that child, in addition to a police officer. If the infant is being moved without the authorized personnel, the system will sound an alert, triggered by HTK's Web-based software. The Elpas system, known as BabyMatch, was deployed six months ago.
DOIHI and the hospital then began considering other RFID applications. This led to the facility's use of passive EPC Gen 2 UHF tags to track and manage surgical tools and other assets, utilizing HTK's Asset App Web-based software and Android-based app for tablets.
The hospital has a variety of assets, including medical equipment, computers, printers and office furniture, that DOIHI would like to track automatically. Before the RFID system was adopted, medical equipment and furnishings were tracked via serial numbers on stickers and bar codes. The hospital managed its surgical instruments by having employees visually inspect laser-engraved serial numbers.
In 2015, DOIHI installed Convergence Systems Ltd. (CSL) CS203 readers with integrated antennas at 35 locations. It also attached 9,000 Confidex Steelwave Micro and Carrier Pro tags to such assets as wheelchairs, beds, pumps, tables, electronic medical equipment and IT assets.
All 35 readers are installed in specific areas so that DOIHI can determine which assets have been moved into a new zone or building. In the software, a user can view a virtual map that displays where a specific item can be located, according to the zone in which it was last detected. In addition, hospital personnel use a CS101 handheld reader to locate specific assets within a zone, or to conduct inventories when necessary.
The high cost of managing the surgical tools was a concern for DOIHI as well, Lopez Arango says. Employees spent many hours individually counting the instruments before they were taken to surgery, and then counting them again after the procedure, and when they were removed from inventory for maintenance. Despite these multiple counts, some items still ended up missing.
"In the Mexican market, there are [not many] options for surgical instruments' RFID-tagging," Lopez Arango explains. There are solutions involving laser-engraved bar codes or QR codes, he says, but the company preferred to use radio frequency identification.
For tracking surgical tools, Haddad says, HTK provided handheld RFID readers from Technology Solutions Ltd. (TSL) that communicated with Android-based tablets via a Bluetooth connection. HTK also supplied Xerafy passive EPC Gen 2 UHF RFID tags. A tag was glued to each surgical instrument, and the unique ID number encoded to that tag was paired in the HTK software with details about the tool to which it was attached. The tags are first read using a TSL RFID reader in the sterilization area when the tools are cleaned and ready for use.
When the tools leave the autoclave, they are packed into sterilized kits specific to each surgery. Staff members use the TSL reader to interrogate the tag of every tool in a particular kit, thereby confirming which items are in that kit. The collected read data is stored in the HTK software residing on DOIHI's asset-management software. In the event of an error, the tablet displays an alert to the individual packing that kit.
Previously, employees had to unwrap the tools in order to visually inspect them prior to surgery. Now, that data is available via RFID, and the tools can remain in their sterilized packaging.
Another handheld TSL device in the operating room is used to read the tags of the tools within the kit once it is delivered to surgery. As each tool is removed from the kit for the operation, its tag is again read, thus creating a record of which tool was used at which time, and with which patient. To protect the TSL handheld from being contaminated by bacteria, the device is covered with a sterilized disposable bag composed of the same material used to make facemasks.
As kits are returned to the cleaning and sterilization area, those requiring repairs are removed from the others. Nurses then utilize the handheld to capture the tag IDs of the kit's tools, and to view each item's history, as well as input any details, such as the type of repair being scheduled.
The facility faced some challenges related to putting the tags through repetitive washing and sterilization processes, Lopez Arango reports. For one thing, "the water in this part of Mexico," he explains, has "many salts and minerals." To prevent surgical instruments from becoming stained, DOIHI has installed reverse osmosis equipment to remove these minerals and salts, and also sandblasts the equipment to clean off deposits. However, he notes, that process could damage or destroy the tags. "We tested with the company that provides the pressure sand process, and the solution was simple—covering the tag avoided any damage." Workers accomplish this by simply placing special tape over each tag before it undergoes the sandblasting process.
HTK and DOIHI have tested the tags through autoclaving 900 times. The tags were attached via a specialized glue provided by Xerafy, and DOIHI is currently awaiting the results of tests conducted to ensure that the adhesive cannot carry bacteria from one surgical procedure to the next. Within a few weeks, following a review of those results, the organization plans to tag approximately 150 instruments daily, until 11,000 items are tagged. About 97 percent of all surgical tools will be fitted with the Xerafy RFID tags, with the exception of microsurgery instruments, which are too small to be tagged.
Thus far, Lopez Arango says, the piloted RFID system has eliminated instrument loss, while increasing the speed at which tools are counted at the beginning and end of every surgery. "To date, we are still in the implementation and development of the [full instrument tagging] project," he states, "which we hope to finish in July 2016."
DOIHI has also begun expanding its RFID reader deployment to a total of 13 surgical rooms. The installation, Lopez Arango reports, is expected to be completed within one year. He adds that DOIHI and the medical facility are RFID pioneers in Latin America. "We are the first hospital in Mexico, Central and South America that has this RFID technology in surgical kits," he says.
